Candidiasis of genitalias represents the infectious disease of urinogenital system caused by drozhzhepodobny mushrooms of the sort Candida. Feature of this disease is the long current and tendency to recuring. The vulvovaginitis belongs to the most frequent forms of candidiasis of genitalias at women, men have a balanoposthitis.
According to various authors, from 35 to 50% of all cases of an infectious vulvovaginitis fall to the share of a candidosis vulvovaginitis. 75% of women throughout life have, at least, 1 episode of candidiasis of genitalias, at 40 — 45% — 2 and more. Approximately recurrent candidiasis develops in 5% of cases (4 and more recurrence within a year).
Classification On MKB-10: • candidiasis of a vulva and vagina; • candidiasis of other urogenital localizations (balanitis, urethritis). In daily clinical practice for the solution of a question of tactics of maintaining patients it is reasonable to use clinical classification: • primary candidiasis of genitalias; • recurrent candidiasis of genitalias (4 and more recurrence a year).
As the activator serve drozhzhepodobny mushrooms of the sort Candida (in 80 — 90% of cases of S. of albicans, in 5 — 10% — Torulopsis glabrata). 5 — 6% of cases are the share of a share of other types (C. tropicalis, C. krusei, C. guilliermondi, C. parapsilosis). Drozhzhepodobny mushrooms represent asporogenic unicells of an oval form from five - or a six-layer cell wall. The Psevdomitselialny forms of a mushroom are had the perforative body having the expressed damaging effect on macroorganism cells. Reproduction happens by budding; at the same time in addition to a blastospor the pseudo-mycelium which is considered as an important patrimonial sign of mushrooms of Candida is formed. Drozhzhepodobny mushrooms are steady against environmental factors (processings of 2 — 5% solution of formalin or chloroamine perish after boiling within several minutes, or). Mushrooms of the sort Candida possess various virulence, are capable to form the filterable forms representing active allergens. The page of albicans comes to light at healthy women, however at change of a microbiocenosis of a vagina and disturbance of barrier mechanisms of local immunity can gain pathogenic properties. Long therapy by antibiotics, hormonal medicines, use of immunodepressants, radiation therapy, serious infectious diseases, pregnancy, diseases of a gastrointestinal tract and endocrine system, in particular a diabetes mellitus belong to risk factors of development of candidiasis of genitalias.
Under the influence of adverse factors there is an adhesion and growth of mushrooms of Candida on a blanket of a mucous membrane of a vagina to a further invasion in an epithelium, destruction of an epithelial cell and hematogenous dissimination of the activator which leads to emergence of the secondary centers in various bodies and fabrics. At reproduction of elements of a mushroom (blastospor) filamentous forms (pseudo-mycelium) form. Mushrooms produce endotoxin, proteolytic and sakharolitichesky enzymes which formation serves as an origin of an intensive itch. Generalization of process is promoted by immaturity or disturbance of mechanisms of cellular and humoral immunity.
Clinical signs and symptoms of candidiasis of genitalias
Symptoms of candidiasis of genitalias at women (vulvovaginitis): • dense, white, curdled, sometimes liquid, slivkoobrazny allocations from a vagina; • an itch in a vulva and a vagina; • hyperemia, puffiness and dryness of a mucous membrane of a vulva and vagina, sometimes small bubbles, erosion and cracks; • at part of patients the dispareuniya, a dysuria is observed. The asymptomatic carriage is noted at 15 — 20% of women in the reproductive and premenopauzalny period. Also it is necessary to consider that in the presence of clinical symptoms of candidiasis results of laboratory researches can be negative. Detection of mushrooms of Candida does not form the basis for purpose of treatment for lack of clinical symptoms of candidiasis. Symptoms of candidiasis of genitalias at men (a balanitis, a balanoposthitis): • a moderate itch and burning in external genitals; • puffiness, a hyperemia, a superficial peeling, a whitish plaque on a balanus and on an internal leaf of a prepuce; • in some cases on skin of a balanus and prepuce there can be papules turning into superficial pustules and bubbles, and then into the characteristic roundish erosion and cracks at a chronic current leading to narrowing of a prepuce and formation of a phymosis. Formation of erosion most often happens on the adjoining sites of skin of a balanus and an internal leaf of a preputial bag. Quite often candidiasis of genitalias is combined with candidiasis of an urinary system; at the same time there can be an urethritis or cystitis.
The diagnosis and the recommended clinical trials
The diagnosis is established on the basis of features of a clinical picture and results of laboratory methods. Laboratory researches: • microscopic examination of the native or painted across Gram drug allows not only to reveal existence of Candida with dominance of vegetans forms of a mushroom (a mycelium and the budding yeast cells), but also to estimate structure of microflora of a vagina (pathogenic and opportunistic microorganisms) and expressiveness of leukocytic reaction; • bacteriological research allows to define specific accessory of the allocated culture of a mushroom and the accompanying microorganisms, and also to estimate medicinal sensitivity. Diagnostically growth of colonies of mushrooms> 104 WHICH serves significant.
Differential diagnosis of a disease
The differential diagnosis is carried out with the specific urogenital infections caused pathogenic (N. gonorrhoeae, T. vaginalis, C. trachoma-tis) and opportunistic microorganisms, and also infectious diseases of a virus etiology (genital herpes) on the basis of clinical laboratory criteria.
Treatment of candidiasis of genitalias
Medicines of the choice serve drugs with antifungal activity from group of imidazoles and triazoles. At primary episode of candidiasis of genitalias at women the main medicines: Izokonazol intravaginalno 600 mg (a vaginal ball) once for the night or Clotrimazolum intravaginalno 200 mg (a vaginal tablet) for the night, 3 days or 1%o cream, intravaginalno 5 g, 6 days.
Alternative medicines: Natamitsin intravaginalno 150 mg (a vaginal tablet) 1 r / days, 3 — 6 days or Flukonazol in 150 mg once or Ekonazol intravaginalno 150 mg (vaginal candle) 1 r / days, 3 days. At candidiasis of genitalias at men: Clotrimazolum, 1% cream, on the defeat centers (a thin layer) 2 r / days, 14 days or Flukonazol in 150 mg once. At recurrent candidiasis of a vulva and vagina: Itrakonazol in 200 mg, 1 days during 3 days or Flukonazol in 150 mg once.
At candidiasis of a vulva and vagina at pregnant women: Izokonazol intravaginalno 600 mg (a vaginal ball) once for the night or Clotrimazolum intravaginalno 200 mg (a vaginal tablet) for the night or 1% cream, intravagi-nalno 5 g, no more than 7 days or Natamitsin intravaginalno 150 mg (vaginal tablet) 1 r / days, 6 days or Ekonazol intravaginalno 150 mg (vaginal candle) 1 r / days, 3 days. At urogenital candidiasis at children: Flukonazol in 1 — 2 mg/kg once or Pimafutsin-krem on focal defeat 2 r / days within 14 days. Creams and candles for topical administration are made on an oil basis and can damage structure of latex condoms and diaphragms. During treatment and dispensary observation use of condoms is recommended during sexual contacts. At inefficiency of treatment the reuse of one of alternative medicines is recommended.
At frequent recuring complex inspection by other specialists is necessary (the endocrinologist, the gastroenterologist, etc.).
Assessment of efficiency of treatment
The assessment of efficiency of treatment is carried out in 7 — 10 days after completion of therapy. As criteria of treatment serve disappearance of symptoms of a disease and negative takes microbiological issledova-